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Islet Transplantation May Slow Progression of Atherosclerosis in Diabetes Patients

Minimally invasive islet transplantation for patients with type 1 diabetes achieves insulin independence and reverses the progression of atherosclerosis in the first few years after transplant, according to a study conducted at the University of Illinois at Chicago.

The new research was published in the February issue of Diabetes Care.

Patients with diabetes, particularly women, have a substantial increased risk of dying from ischemic heart disease, according to previous research. However, future cardiac events may be prevented with intensive glycemic control.

In the new longitudinal study, researchers looked at changes over time in carotid intima–media thickness (CIMT) — a marker for atherosclerosis — in a group of type 1 diabetes patients without kidney disease or previous cardiovascular events.

“This is the first study to look at what happens to diabetes-related cardiovascular complications after islet cell transplantation alone without kidney transplant,” said lead author Dr. Kirstie Danielson, who noted that previous research has focused on metabolic changes and glycemic control after transplant.

Fifteen adults (two men and 13 women) had type 1 diabetes for more than 5 years and had hypoglycemic unawareness despite efforts to manage insulin levels. The patients received a total of 27 islet transplantations (one to three transplants each) and were followed from 1 to 5 years after their first transplant. CIMT was measured before and approximately every 12 months after the first islet transplantation.

The researchers found a significant decrease in CIMT at 1 year after islet transplantations. The CIMT measures started to progress again — slightly more than they would in healthy individuals without diabetes — at between 12 and 50 months. At 50 months post-transplant, the CIMT measures were still lower than pre-transplant levels, Danielson said.

All 15 patients achieved insulin independence after receiving one to three islet transplantations. At the end of the new study, 11 patients were insulin-free; three remained on insulin but at greatly reduced doses; and one patient withdrew from the trial because of islet graft loss.

The next step will be to replicate the results in a larger trial, Danielson said.